Incidence trends of pediatric onset inflammatory bowel disease in the years 2000-2009 in Saxony, Germany-first results of the Saxon Pediatric IBD Registry.

AIMS: In developed countries, the incidence of inflammatory bowel disease (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC) is increasing. Therefore, we aimed to investigate the incidence rates and trends over time in the population of children and adolescents in one of the federal states of Germany, in Saxony. METHODS: Over the 10-year period 2000-2009 all 31 children's hospitals and pediatric gastroenterologists, respectively in Saxony reported all IBD patients up to 15 years of age to the Saxon Pediatric IBD Registry. The completeness of the registry was estimated as 96.7% by independent surveys in the years 2005-2009. Incidence rates were presented as age-standardized incidence rates (ASR) regarding New European Standard Population 1990 per 100,000 person-years (PY) with 95% confidence intervals [CI]. Joinpoint and linear regression was used for trend analyses. RESULTS: 344 patients with confirmed IBD between 2000-2009 were included in the epidemiological evaluation: 212 (61.6%) patients with CD, 122 (35.6%) with UC and 10 (2.9%) with unclassified IBD (IBD-U). The ASR per 100,000 PY over the whole observation period was 7.2 [6.4-7.9] for IBD, 4.4 [3.8-5.0] for CD, 2.6 [2.1-3.0] for UC and 0.2 [0.1-0.3] for IBD-U. For IBD, the ASR per 100,000 PY increased from 4.6 [2.8-6.3] in 2000 to 10.5 [7.5-13.6] in 2009. The incidence trend analysis of ASRs using the joinpoint regression confirmed a significant increase of IBD as well as UC. The mean age at first diagnosis decreased significantly during the observation period from 11.5 (11.0-13.4) in 2000 to 9.6 (5.1-13.5) years in 2009. The median of the diagnostic latency among IBD patients was 3 months. CONCLUSION: The incidence of IBD in children and adolescents in Saxony was slightly higher than the average of other countries in the same time period and followed the trend towards a general increase of IBD. The age at diagnosis was subject to a very unfavorable downward trend.

Incidence of childhood diabetes in children aged less than 15 years and its clinical and metabolic characteristics at the time of diagnosis: data from the Childhood Diabetes Registry of Saxony, Germany.

AIMS: The Childhood Diabetes Registry in Saxony, Germany, examined the incidence and metabolic characteristics of childhood diabetes. METHODS: In the federal state of Saxony, newly diagnosed cases of diabetes in children and adolescents aged less than 15 years were registered continuously from 1999 until 2008. Family history, date of diagnosis, clinical and laboratory parameters were obtained. Reported cases were ascertained by public health departments as an independent data source and verified using the capture- recapture method. RESULTS: A total of 865 children and adolescents with newly diagnosed diabetes were registered in Saxony. About 96% of them were classified as having type 1 diabetes, 0.6% had type 2 diabetes, 2.4% had maturity-onset diabetes of the young (MODY), and 1.4% had other types of diabetes. The age-standardized incidence rate of type 1 diabetes was estimated at 17.5 per 100,000 children per year. Completeness of ascertainment as calculated by the capture-recapture method amounted to 93.6%. At the time of diagnosis, 27.1% of children with type 1 diabetes had ketoacidosis, 1.5% had a blood pH <7.0, and 1.1% were unconscious. CONCLUSION: The registry provided data about the incidence rates and clinical presentation of childhood diabetes in a defined German population. We observed higher incidence rates compared to previous surveys.

[Prevention in occupational health care--a societal challenge]. / Prävention im betrieblichen Setting--eine gesellschaftliche Aufgabe.

The metabolic syndrome, increasingly appearing amongst the elderly and recently in younger people with a most sudden increase in the age group < 30 years, is one of the main threats to European health in this century. Early diagnosis is the most efficient way to manage and to prevent metabolic syndrome from developing. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, reduced the risk of developing diabetes and metabolic syndrome. The challenges today are to develop and implement efficient strategies to identify those on risk and to implement prevention management programs for clinical practice. Company medical officers could play an important role while identifying persons with increased risk for the metabolic syndrome, because they are addressing patients and healthy working persons but also reaching persons who normally are not reached by the health-care system. The occupational medical health promotion has the structural requirement to implement preventive intervention also by using its influence to establish healthy workplaces. Implementing managed prevention programs in the occupational medical care setting will enable prevention of the metabolic syndrome without consuming large resources. This process will be challenging and must be sustainable requiring many partners but resulting in a profitable chance for occupational health care.

Evaluation of a diabetes management system based on practice guidelines, integrated care, and continuous quality management in a Federal State of Germany: a population-based approach to health care research.

OBJECTIVE: The aim of this study was to evaluate the Saxon Diabetes Management Program (SDMP), which is based on integrated practice guidelines, shared care, and integrated quality management. The SDMP was implemented into diabetes contracts between health insurance providers, general practitioners (GPs), and diabetes specialized practitioners (DSPs) unified in the Saxon association of Statutory Health Insurance Physicians. RESEARCH DESIGN AND METHODS: The evaluation of the SDMP in Germany represents a real-world study by using clinical data collected from participating physicians. Between 2000 and 2002 all DSPs and about 75% of the GPs in Saxony participated. Finally, 291,771 patients were included in the SDMP. Cross-sectional data were evaluated at the beginning of 2000 (group A1) and at the end of 2002 (group A2). A subcohort of 105,204 patients was followed over a period of 3 years (group B). RESULTS: The statewide implementation of the SDMP resulted in a change in therapeutic practice and in better cooperation. The median A1C at the time of referral to DSPs decreased from 8.5 to 7.5%, and so did the overall mean. At the end, 78 and 61% of group B achieved the targets for A1C and blood pressure, respectively, recommended by the guidelines compared with 69 and 50% at baseline. Patients with poorly controlled diabetes benefited the most. Preexisting regional differences were aligned. CONCLUSIONS: Integrated care disease management with practicable integrated quality management including collaboration between GPs and specialist services is a significant innovation in chronic care management and an efficient way to improve diabetes care continuously.

[Rigid RSA DMP for Type-2 Diabetes Mellitus: results of a three-state survey]. / Rigides RSA-DMP Diabe- tes mellitus Typ 2: Bilanz einer 3-Länder-Umfrage.

Diabetes contracts, such as those used in Saxony, were already excellent, effective diabetes programs in line with the concept of disease management. This was due to well-accepted practical guidelines and to an integrated care concept that was implemented with little bureaucratic effort through an internal quality-control management; this was based in turn on rapid, practicable documentation in the framework of interdisciplinary quality round tables. The present RSA DMP, in contrast, are to be fundamentally improved and simplified. This must occur also in view of the handling of guidelines, so that these do not jeopardize well-established and positively-evaluated healthcare programs (and along with that the quality of patient care) in the regions with well-functioning systems. In view of the persistent critiques on form and content of the state-regulated chronic-disease programs, the group "DMP in Central Germany", representing the German federal states of Saxony, SaxonyAnhalt, and Thuringia, initiated at the end of 2003 a structured survey for the evaluation of the RSA DMP Type 2 Diabetes among general practitioners and diabetes specialists. Particularly critical evaluations of the RSA DMP originate from the federal states with well-developed guideline-based diabetes care programs, for example in the new Eastern federal states, Nord Rhine-Westphalia, and Bavaria. With its minimal standards, the RSA DMP does not represent any progress in these regions and does not contribute to cost reduction. Detailed medical contents and professional guidelines do not belong to a law ordinance but to the already existing medical guidelines.